Project 2: '1 he goal oi this project is to assess the effectiveness of a dental disease prevention management model based on an infant oral care program. The intervention is aimed at reducing the prevalence of early childhood caries (ECC) in an underserved community and improving access to preventive dental services for pregnant women, their infants and toddlers. High-risk children include those with early signs of ECC, poor oral hygiene, limited exposure to fluorides, and fiequent exposure to high dietary sugars. These children and their caregivers will be targeted with a professional preventive program that includes anticipatory guidance counseling, the use of chlorhexidine rinses for postpartum women and the application of fluoride varnish for their infants. This proposal relates to the theme of the Centers for Research to Reduce Oral Health Disparities by reducing dental disparities among a population at high risk for dental disease located at the US-Mexican border. The multidisciplinary team brings together a collaborative effort between the University of California, San Francisco, San Ysidro Community Health Center, San Diego State University and the University of California, Los Angeles. This collaboration will provide expertise in the development of scientific evidence based research in the community health center environment by identifying the best prevention strategies for ECC in an underserved population where oral health disparities are epidemic. The relevance of the project model is its potential for replication and transfer to other community health centers and public health entities through the integration of oral health promotion and disease prevention as part of a multidisciplinary approach with other health services. The specific aims of the proposed clinical research study are: 1) To identify an effective disease prevention behavioral management model for ECC starting with prenatal care and with collaboration of other health care providers and services; 2) To compare the efficacy of two prospective interventions for pregnant women and their newborns: counseling alone versus counseling combined with chlorhexidine rinses for mothers and the use of fluoride varnish for infants; 3) To assess the risk for ECC based on a monoclonal antibody caries diagnosis test in very young children and their mothers (caregivers); 4) To assess the effectiveness of a caries-preventive regimen in lowering the salivary mutans streptococci level in post-partum women and, subsequently, in inhibiting the growth of these bacteria in their young children, delaying the infectious process. Early screening for signs of caries development, starting from the first year of life, will identify infants and toddlers who are at risk of developing ECC and will assist in providing information to parents from an underserved community about the promotion of oral health and prevention of dental disease.